![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 44. Go back in thread:
Posted by morganator on August 23, 2009, at 22:28:52
In reply to Re: Do Antidepressants extend lifespan?, posted by bleauberry on August 23, 2009, at 17:02:40
Any time an antidepressant was working for me I felt much less stressed. I was able to deal with stressful events much easier. I slept much better. I worked more efficiently. I got better workouts and the benefit from the workout lasted much longer.
And the only reason why I am in bad shape at the moment is because I stopped taking my medication and did some other things to hurt myself around the same time. If I were more aware of my illness(I am bipolar), I may have not stopped medication.
If you feel good on medication, you feel less stress. It's as simple as that
Posted by yxibow on August 23, 2009, at 23:40:29
In reply to Re: Do Antidepressants extend lifespan?, posted by bleauberry on August 23, 2009, at 17:02:40
> Do Antidepressants extend lifespan?
>
> No.
>
> Longterm followup studies show it.Which?
And if the semantics are misconstrued in this, I don't believe that antidepressants are "life extension" supplements that some people believe will make them live to 200 years old or whatever.
> Stress is not reduced.
> Suicides are not reduced.
> Underlying diseases progress while misdiagnosed as depression.
> New diseases/syndromes are created.
> Remissions are a minority and commonly relapse within 3 years.
>
> Actually unmedicated depression patients who just try to live as healthy as they can the remainder of their miserable lives live longer than the medicated ones.I also can't believe what borders on complete lack of concern for people with depression
> Stress is not reduced.
No, depression has been commpletely unstressful to me... I feel perfectly at ease with primary and second depression. I've loved having problems, bleauberry.
"> Suicides are not reduced."
WTF ?? Of course they are in people who are suicidal who respond to medication. I've never thought about that at all.
> Underlying diseases progress while misdiagnosed as depression.
Yes, we know, Lyme, Lyme, Lyme.
In all fairness though, comorbid diseases are always going to be there. I'm quite sure I've had the common cold.
> New diseases/syndromes are created.
Side effects occur. Yes, I've had neurological consequences which are RARE to most other people and I'm not happy about that. But I'd be a lot worse without something on board.
> Remissions are a minority and commonly relapse within 3 years.
And where did this scientific paper quote come from?
There are plenty of success stories, antidepressant or therapy or both otherwise.
There's no such thing as 100% remission of anything, there's no "perfect" person.
But if you're successful with medication and continue to take it, you will likely to continue to experience this for some time to come, and that's more than 3 years.
Sorry, I'm trying to be civil, but this is really unfair to people who are fighting for their life and livelihood with depression on this board.-- Jay
Posted by SLS on August 24, 2009, at 5:43:30
In reply to Re: Do Antidepressants extend lifespan? » bleauberry, posted by yxibow on August 23, 2009, at 23:40:29
> there's no "perfect" person.
I beg to differ.
:-)
- Scott
Posted by yxibow on August 24, 2009, at 6:41:26
In reply to Re: Do Antidepressants extend lifespan?, posted by SLS on August 24, 2009, at 5:43:30
> > there's no "perfect" person.
>
> I beg to differ.
>
> :-)
>
>
> - Scott
>Well of course we should have people love each other and call each other/us perfect! :)
I was responding to the intrinsic nature that down to the last genome, nobody is flawless.
And I don't know quite how the first sentence I wrote so perfectly fits into the movie I just watched, Sleeping Dogs Lie.(Warning, some people may not find the irony in my sentence or the movie their taste. That is, the one by 'Bobcat' Goldthwait)
-- Jay
Posted by SLS on August 24, 2009, at 7:16:30
In reply to Re: Do Antidepressants extend lifespan? » SLS, posted by yxibow on August 24, 2009, at 6:41:26
> > > there's no "perfect" person.
> > I beg to differ.
> >
> > :-)
> Well of course we should have people love each other and call each other/us perfect! :)
Perfect love is to love the imperfect.I had a real problem with that when I was younger. I was always looking for the perfect woman. It wasn't until I stopped doing this that I found someone who, at the time, was perfect for me.
- Scott
Posted by yxibow on August 24, 2009, at 7:35:10
In reply to Re: Do Antidepressants extend lifespan?, posted by SLS on August 24, 2009, at 7:16:30
> > > > there's no "perfect" person.
>
>
> > > I beg to differ.
> > >
> > > :-)
>
>
> > Well of course we should have people love each other and call each other/us perfect! :)
>
>
> Perfect love is to love the imperfect.
>
> I had a real problem with that when I was younger. I was always looking for the perfect woman. It wasn't until I stopped doing this that I found someone who, at the time, was perfect for me.
>
>
> - Scott
Exactly, it was a short way of summarizing it with an amusing and sad and potentially not someone's taste in a movie example.
Its what I meant. And I hope someone can find the reverse in myself, because there are so many things going on.... anyhow... I don't want to go down there, its been really a bad set of symptoms lately.-- Jay
Posted by SLS on August 24, 2009, at 7:49:14
In reply to Re: Do Antidepressants extend lifespan? » SLS, posted by yxibow on August 24, 2009, at 7:35:10
> I don't want to go down there, its been really a bad set of symptoms lately.
>
> -- Jay
Sorry to hear that. I hope things resolve soon.
- Scott
Posted by Ron Hill on August 24, 2009, at 17:15:52
In reply to Re: Do Antidepressants extend lifespan?, posted by SLS on August 24, 2009, at 5:43:30
> > there's no "perfect" person.
>
> I beg to differ.
>
> :-)
>
>
> - Scott
>And humble too!
(-:
-- Ron
Posted by yxibow on August 24, 2009, at 17:18:52
In reply to Re: Do Antidepressants extend lifespan? » yxibow, posted by SLS on August 24, 2009, at 7:49:14
> > I don't want to go down there, its been really a bad set of symptoms lately.
> >
> > -- Jay
>
>
> Sorry to hear that. I hope things resolve soon.
>
>
> - ScottThanks Scott, you're kind... well, this particularly strange and distressing set of the same 24/7 phenomenon that has been going on for almost 8 years, has been going on for 2 1/2 years, but I guess there's always chances....
-- Jay
Posted by bleauberry on August 25, 2009, at 18:09:42
In reply to Do Antidepressants extend lifespan?, posted by trainspotter on August 20, 2009, at 11:03:06
My previous response provoked a surprising uprising of emotions. That was not intended. I am sorry that happened.
As Dr Bob's disclaimer says, don't believe everything you see here. Opinions are opinions, everyone has them. Mine were not meant to cause an uprising. Mine are formed from a combination of "big picture", "scientific evidence", "anecdotal evidence", and "both sides of the fence views" all combined. I believe it is important for everyone to become as informed as possible on both sides of any debate before taking one's own side, and to strictly set aside personal emotions, biases, and preheld beliefs while gathering information.
I'm sick like you. On a day with more energy and time I would hunt for studies I saw. Do I trust those studies? Somewhat, not completely. Anywhere humans are involved, errors are inevitable. But they do become part of the "big Picture" "both sides of the fence".
Do I trust anecdotal evidence? Same as above.
Not mentioning the poster's name, I took the comments, "Lyme, lyme, lyme" very personally. That was a punch between the legs and a rather immature heartless malignant stab. You are forgiven my friend and I ask blessings on your day.
There is scientific evidence that the antidepessant Mianserin extends the life of nematodes by 30%. No other drug in hundreds did that.
There was someone on this earth who was perfect and flawless. You may have heard of JESUS?
My overall opinion remains that antidepressants can extend the lifespan of individual people on individual cases, but that when a sample population of thousands is considered, lifespan is shorter overall as a group. The reasons are involved and lengthy.
Longterm antidepressant samples have equal suicide rates as non-antidepressant samples. Studies are flawed in one way or another, interpretations can be twisted by any viewer, and I take that into account.
In the shortrun there is no doubt that the correct antidepressant for the correct person can add some years to their life. I just think that somewhere later in the majority of people's lives, those years are taken back. Alas, they were only borrowed.
Posted by Sigismund on August 25, 2009, at 20:07:37
In reply to Re: Do Antidepressants.....Response to All, posted by bleauberry on August 25, 2009, at 18:09:42
We're all different here and we all have to find our own way.
I am thankful that there is such a variety of approaches represented on the boards.
There are people who I don't agree with from whom I have learned a great deal.
It is sometimes personally challenging, but I think we should welcome this.
Posted by yxibow on August 25, 2009, at 23:15:20
In reply to Re: Do Antidepressants.....Response to All, posted by bleauberry on August 25, 2009, at 18:09:42
> My previous response provoked a surprising uprising of emotions. That was not intended. I am sorry that happened.
I understand... but you're right, it was emotional.
> As Dr Bob's disclaimer says, don't believe everything you see here. Opinions are opinions, everyone has them. Mine were not meant to cause an uprising. Mine are formed from a combination of "big picture", "scientific evidence", "anecdotal evidence", and "both sides of the fence views" all combined. I believe it is important for everyone to become as informed as possible on both sides of any debate before taking one's own side, and to strictly set aside personal emotions, biases, and preheld beliefs while gathering information.
And you're entitled to your opinion, and its quite true I don't believe everything I see here -- this isn't aimed at anyone in particular but I see a lot of antipsychiatry and questionable information that doesn't examine cause and effect, and causation is not always causality.
I see surprising and unexplainable things that people believe cause them depression, which I question causation/causality.
But on the other hand I am incredibly sensitive to -certain- medications, not all, so I understand what a rare side effect and what medications can do. I am an example of that.
> I'm sick like you. On a day with more energy and time I would hunt for studies I saw. Do I trust those studies? Somewhat, not completely. Anywhere humans are involved, errors are inevitable. But they do become part of the "big Picture" "both sides of the fence".
I am rather poorly too. Its not a good state at the moment. I also have hunted for studies, although I base them on HonCode, and scientific journals that I happen to have access to or PubMed citations.> Do I trust anecdotal evidence? Same as above.
No comment there... although I can theorize from a real peer reviewed journal that there is perhaps promise from a case study (like 3 people) but that doesn't provide enough information base.
> Not mentioning the poster's name, I took the comments, "Lyme, lyme, lyme" very personally. That was a punch between the legs and a rather immature heartless malignant stab. You are forgiven my friend and I ask blessings on your day.I'm sorry about that, and I apologize. Its very hard sometimes on here where this is the MEDICINE board and not the alternative board and I see certain things stated over and over again....
....about alternative theories that include dangerous practices of things such as chelation which should only be done in medical emergencies
..... and contrary to standard psychiatric practice advice about how first one should always be checked for Lyme disease.
And I cracked. I'm sorry to offend you. I am strangled every time I post on here by civility rules. Admittedly it was coarse... I'm trying to figure a way I could have said it civilly and yet strangling what I really wanted to say which is that I think is..... well.... can't say it on here.
I don't pretend to be above anyone's views and I try not to "practice medicine without a license" but I guess without saying anything more, I believe in things that come from relative to strongly mainstream medical journals. That's just my view.
Again, I apologize, but we obviously greatly disagree.
(I admit... I had a lot of tests done because I have a disorder category and symptoms that besides two people very vaguely have mentioned, nobody else has such a condition and I still wonder about other tests... dont get me wrong.)
It has gripped me for 8 years and robbed me of what I think most people take for granted of average sensory properties in life (visual amplifications and distortions that I think the average person would find rather scary if they could see through my psychiatric eyes) so maybe I am also bitter.
> There is scientific evidence that the antidepessant Mianserin extends the life of nematodes by 30%. No other drug in hundreds did that.I don't know about that... I haven't seen that study, and I'm not a nematode... its hard to transfer things from other species to humans... sometimes it does, sometimes it doesn't.
Mianserin also has some detractions, and it is why mirtazapine is used these days... and I also see the same Wikipedia study that you mentioned, in Nature.
Yes, Nature is relatively mainstream, but that doesn't mean its absolute. But, so, its interesting, thanks..
I hope some day that the... and I'm probably going to offend someone, I can't help it... mm... ugh... again strangled by "being civil"... anti-scientific religious circle will allow us to use stem cells and other contentious non-living entities to expand what is the forefront of what could help millions of people.> There was someone on this earth who was perfect and flawless. You may have heard of JESUS?
It is impossible to scientifically debate the existence of someones god.
If you believe Jesus was perfect and flawless, then so be it. I can't refute this.
But I am agnostic, and I am Jewish. I am basically not religious, my scientific background makes me agnostic, which means I may believe at times that e.g. perhaps a higher power was looking out for me when I almost went over a cliff. I am strongly culturally though.
Religion helps some people explain the things that cannot be explained otherwise scientifically.And that's fine... in my mind... and here comes the civility again... as long as it is a completely personal belief. This is the same belief I have that people should have basic human rights and be able to do things in life that as best as possible don't infringe on others. As is said, it is hard to please everyone all the time.
I have a strict view of separation of church and state and to an extent the view of the founding Deists of the US. So I cannot countenance proselytizing, infringing on others' human rights (e.g. domestic partnerships, marriage to all, the right for women to have abortions in just about all circumstances, civil liberties and rights to all [e.g. extreme unnamed religion practices of flogging women, not allowing them to drive, putting veils on them, and flying airplanes into buildings occupied by people]).
I could go on about how religion has become the chief ruler of democracy but I wont because again, I am strangled by "being civil".But, and this is going into the religious area, if I recall one is here, and I just can't get into such debates
> My overall opinion remains that antidepressants can extend the lifespan of individual people on individual cases, but that when a sample population of thousands is considered, lifespan is shorter overall as a group. The reasons are involved and lengthy.Actually I believe when a population of thousands are considered its just the same and more valid of a study than 10 people, just like the required amount of people to be in studies for FDA approved medication. But we can disagree.. that's fine.
> Longterm antidepressant samples have equal suicide rates as non-antidepressant samples. Studies are flawed in one way or another, interpretations can be twisted by any viewer, and I take that into account.I agree with the first part, because I believe that all the warnings placed on EVERY antidepressant available in the pharmacy back to the 1950s are put there for CYA (cover your tushy) purposes.
Sure, a sample of people could react in "rare" ways (as a prescribing information notes... 1/1000, 1/10000 or less typically) and have worsened problems that lead to suicide.
But people who are depressed (and the standard gamut of listings of signs, we don't have to describe it all, I'm sure we know this) have a potential to be suicidal in the first place and the medicine may have zero to do with it.
> In the shortrun there is no doubt that the correct antidepressant for the correct person can add some years to their life. I just think that somewhere later in the majority of people's lives, those years are taken back. Alas, they were only borrowed.
I am allowed to disagree with this. There is no guarantees in life, and I have sorely learned this in the past years with an intense disorder I cannot believe is even in the class or state of conditions I have had before and have conquered or gotten around them in a fairly functional manner.
So I can't see how borrowing or taking has validity. It doesn't make sense to me. If you stay on medication, however imperfect it is, and yes, even for me, especially right now, very imperfect, that allows you greater functionality than otherwise, use what you have.Unfortunately, I am really down about "using what I have".
Yes, I have talked alot about me and perhaps not addressed you enough, but its not often I really bare my chest and say what is bothering me not because I dont think people wouldnt be sympathetic and empathic but because they extremely complex things that vex me as much as they have vexed some people that have heard or evaluated my case. Considering for myself, that it happened literally overnight like a snap.
So I will try not to be uncivil and not to offend you. Perhaps it is just better not to debate how I feel strongly. Perhaps we just but heads. I don't know anyway other to put it.
Take my apology, this is not religious, or otherwise, it is just face value to someone who has felt offended and I am sorry for that.-- tidings
Jay
Posted by SLS on August 26, 2009, at 6:19:37
In reply to Re: Do Antidepressants extend lifespan?, posted by bleauberry on August 23, 2009, at 17:02:40
Hi Bleuberry.
You show a lot of courage to post your views, and even more courage to continue to post in the face of opposition. However, you made statements in a manner that would lead a reasonable person to believe they were fact. It is your privilege to post in any manner you wish. I don't doubt that you have a sense of duty to inform people of things you believe will harm them. In kind, I have the privilege, and perhaps the duty, to challenge your opinions, especially since they are stated as fact rather than being qualified as opinions.
The onus is really on you to provide supporting evidence for your statements. I don't know if I will continue posting along this thread about your contentions, but if I do, it is not up to me to disprove anything you have to say. However, I will want to evaluate any supporting evidence you have for your views, and then reevaluate my own belief system.
I believe that the consequences of people acting upon your statements as if they were fact can lead to deleterious behavior, and perhaps shorten their life. That major depressive disorder and bipolar disorder are associated with cardiovascular disease and a shortened life-span is but one fact that I feel you must take into consideration.
http://www.sciencedaily.com/releases/2007/10/071015131515.htmhttp://www.ncbi.nlm.nih.gov/pubmed/2976950
************************************************
> > Do Antidepressants extend lifespan?
> >
> > No.
> >
> > Longterm followup studies show it.
> > Stress is not reduced.
> > Suicides are not reduced.
> > Underlying diseases progress while misdiagnosed as depression.
> > New diseases/syndromes are created.
> > Remissions are a minority and commonly relapse within 3 years.
> >
> > Actually unmedicated depression patients who just try to live as healthy as they can the remainder of their miserable lives live longer than the medicated ones.
>
>
> I can't believe you wrote all of these things.
>
> I disagree with everything.
>
> However, I have a mind that is ready to take a look at any citations you would like to provide us with.
>
> Those are some very weighty conclusions you have come to. I would recommend that anyone who is inclined to be influenced by your post do their own research.
>
> What turned you? Disappointment?
>
>
> - Scott
Posted by trainspotter on August 26, 2009, at 10:34:14
In reply to Re: Do Antidepressants extend lifespan? » bleauberry, posted by SLS on August 26, 2009, at 6:19:37
Once again it's turning into who can insult who! Hey buster no fighting, it increases stress and reduces life, I have other posts about anxiety and panic and many people take this as a supportive group.
Posted by swan600 on August 26, 2009, at 13:48:34
In reply to Re: Do Antidepressants extend lifespan? » bleauberry, posted by SLS on August 26, 2009, at 6:19:37
I read a study that sais it shortens the life span just like a person who smokes.
Posted by Phillipa on August 26, 2009, at 20:18:09
In reply to Re: Do Antidepressants extend lifespan?, posted by swan600 on August 26, 2009, at 13:48:34
And I've read the opposite so who really knows? Phillipa. ps I do know that I no longer have lymes disease. Did once and documentation to prove. The infection control specialist files of my testing and treatments for over two years. Many false negatives but not positives when done over and over again add the MRI"s and spinal fluid taps. But it's gone so I no longer think of it. Whats there now Is basically hormonal no doubt in my mind. But sometimes other meds are needed.
Posted by Garnet71 on August 28, 2009, at 14:49:04
In reply to Re: Do Antidepressants extend lifespan? » swan600, posted by Phillipa on August 26, 2009, at 20:18:09
"lyme,lyme,lyme"
This comment is not directed to anyone in particular, but for the sake of increasing understanding...
...when I discovered one of the top medical schools has a research center dedicated to Lyme disease, it convinced me of the potential impact, importance, and credibility of the disease.
Posted by Phillipa on August 28, 2009, at 20:22:34
In reply to Re: Do Antidepressants extend lifespan?, posted by Garnet71 on August 28, 2009, at 14:49:04
Garnet I subscribe to that newsletter as well. Very informative. Love Phillipa
Posted by yxibow on August 29, 2009, at 0:28:11
In reply to Re: Do Antidepressants extend lifespan?, posted by Garnet71 on August 28, 2009, at 14:49:04
> "lyme,lyme,lyme"
>
> This comment is not directed to anyone in particular, but for the sake of increasing understanding...
>
> ...when I discovered one of the top medical schools has a research center dedicated to Lyme disease, it convinced me of the potential impact, importance, and credibility of the disease.
>
> http://www.columbia-lyme.org/research/cr_research.html
>Well the good old U of Chicago has published the IDSA guidlines for Lyme
Unfortunately I think its one of those journals one can't access from everywhere, but the citation:
Clinical Infectious Diseases 2006;43:10891134
(c) 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4309-0001$15.00
DOI: 10.1086/508667and the article is quite extensive.
But a quick read of it still notes that Lyme disease is not a condition that warrants long term use of antibiotics.
Now, people may have different opinions, that it is under reported, possibly, but while the number of reported cases has risen [from the CDC] (due to population increase and possibly increased reporting, one might surmise) is less than traffic fatalities, influenza deaths, and other conditions one can think of.
And these are reports, not deaths.
http://www.cdc.gov/ncidod/dvbid/lyme/ld_UpClimbLymeDis.htm
The average cases is 9 per 100,000, with about 1/10,000 in the most probable areas, mainly New England states.
-- tidings
Posted by Phillipa on August 29, 2009, at 19:49:18
In reply to Re: Do Antidepressants extend lifespan?, posted by Garnet71 on August 28, 2009, at 14:49:04
Holy Moly was born and raised in Norwalk Ct. Phillipa
Posted by bleauberry on August 31, 2009, at 21:24:57
In reply to Re: Do Antidepressants extend lifespan? » Garnet71, posted by yxibow on August 29, 2009, at 0:28:11
The CDC is a political beauracracy that is in the business of surveillance and monitoring.
They are not in the business of treating actual patients and thus have no direct experience or contact with them.
The clearly offer the disclaimer that their testing guidelines and treatments are for surveillance and monitoring purposes, not intended for clinical use.
Lyme is extremely complicated. We wish it would be so easy as to say take this ABX for 2 months and that's all we can do for you.
You think treating your depression is tricky? Lyme makes your depression look like child's play.
Anyone wishing to comment on the topic, one way or other, doesn't matter, should refrain from doing so until they know more than a cherry picked view of it.
> > "lyme,lyme,lyme"
> >
> > This comment is not directed to anyone in particular, but for the sake of increasing understanding...
> >
> > ...when I discovered one of the top medical schools has a research center dedicated to Lyme disease, it convinced me of the potential impact, importance, and credibility of the disease.
> >
> > http://www.columbia-lyme.org/research/cr_research.html
> >
>
> Well the good old U of Chicago has published the IDSA guidlines for Lyme
>
> Unfortunately I think its one of those journals one can't access from everywhere, but the citation:
>
> Clinical Infectious Diseases 2006;43:10891134
> (c) 2006 by the Infectious Diseases Society of America. All rights reserved.
> 1058-4838/2006/4309-0001$15.00
> DOI: 10.1086/508667
>
> and the article is quite extensive.
>
> But a quick read of it still notes that Lyme disease is not a condition that warrants long term use of antibiotics.
>
>
>
> Now, people may have different opinions, that it is under reported, possibly, but while the number of reported cases has risen [from the CDC] (due to population increase and possibly increased reporting, one might surmise) is less than traffic fatalities, influenza deaths, and other conditions one can think of.
>
> And these are reports, not deaths.
>
> http://www.cdc.gov/ncidod/dvbid/lyme/ld_UpClimbLymeDis.htm
>
> The average cases is 9 per 100,000, with about 1/10,000 in the most probable areas, mainly New England states.
>
>
> -- tidings
Posted by yxibow on September 1, 2009, at 5:14:19
In reply to Re: Do Antidepressants extend lifespan? » yxibow, posted by bleauberry on August 31, 2009, at 21:24:57
> The CDC is a political beauracracy that is in the business of surveillance and monitoring.
>
> They are not in the business of treating actual patients and thus have no direct experience or contact with them.
>
> The clearly offer the disclaimer that their testing guidelines and treatments are for surveillance and monitoring purposes, not intended for clinical use.
>
> Lyme is extremely complicated. We wish it would be so easy as to say take this ABX for 2 months and that's all we can do for you.
>
> You think treating your depression is tricky? Lyme makes your depression look like child's play.
>
> Anyone wishing to comment on the topic, one way or other, doesn't matter, should refrain from doing so until they know more than a cherry picked view of it.I thought I would just stop because its pointless to get into arguments that become uncivil but this is too provocative.
I'm sorry, I don't really believe in generalizations and conspiracy theories. The CDC is a research institution associated with the US government founded just after the war.
One of its first tasks was to control malaria which was still rampant. Yes, DDT was used and we now know that we can't use this and malathion is usually used today, but it was effective against something that was at the time potentially a debilitating disease in the US still.
It doesn't just pay lip service to diseases; monitoring is important to epidemiology and gathering information on existing and emerging diseases in the US.
They continue to provide valuable assistance to first responders and assess threats of potential activity.
They are involved in research as well as prevention of diseases.. that's where the "and Prevention" comes from.
And as for your comment on "cherry picking", people are welcome to post their views on any subject on here just as much as your generalization of an agency.Yes, the director of the agency is an appointment of the president and if one wants to make any political comments, that's where it can be generalized as "bureaucracy", but many agencies of the government also have some form of appointments as well for better or worse.
But I especially am taken aback that somehow my condition is "child's play" compared to Lyme Disease.
I've been sick for 8 years with a disorder that only parts of it are known, the etiology/onset and source of its continuation are not particularly known unlike Lyme disease which has a blatant and clear vector and organism responsible for what I'm not denying are some fairly nasty symptoms that may persist even after one no longer tests positive for anything.
So to be clear, I'm no happy camper either. Try standing at an intersection and perceive cars going by at 150% and more of their speed, knowing this isn't true, and not knowing any way of controlling this emergent symptom that has been with me for more than two years.And I could go on with primary and secondary depression, massive weight gain, somatic issues and iatrogenic neurological conditions and a half dozen catch-22 situations.
I hope you have resolution to what ails you but that doesn't require comparison of things, including myself, if I sound upset, I am, but just had to put it out there.So sorry for implying any above comparison. I just needed to get it out there. I rarely say anything much about myself.
Good day and let's just leave things here.
Posted by SLS on September 1, 2009, at 6:01:09
In reply to Re: Do Antidepressants extend lifespan? » bleauberry, posted by yxibow on September 1, 2009, at 5:14:19
Yxibow, thanks for posting what I find to be a valid defense of the CDC. I also want to thank you for sharing some information about your own plight. It is FAR from being child's play. I am not sure I would have the positive and constructive attitude you display in the face of such an enigmatic illness.
Bleuberry, my doctor is one of the foremost experts in the area of the diagnosis and treatment of Lyme Disease. He is not afraid to evaluate a psychiatric presentation as Lyme. He even ran me through a course of doxycyline treatment. He was hoping it would make me feel worse in the beginning. I'm sure you understand why. The next time I speak to him, I'll try to remember to ask him what is the rate of infection.
- Scott
Posted by SLS on September 1, 2009, at 6:08:39
In reply to Re: Do Antidepressants extend lifespan? » bleauberry, posted by yxibow on September 1, 2009, at 5:14:19
Jay, something occurred to me. I am curious. Are anticonvulsants ever used for your condition?
I would TOTALLY understand were you to decide against commenting on this.
I know that your treatment is multimodal, and that you are working your butt off.
Anyway, I hope that you feel better soon.
- Scott
Posted by bleauberry on September 1, 2009, at 17:59:58
In reply to Re: Do Antidepressants extend lifespan?, posted by SLS on September 1, 2009, at 6:01:09
Scott, this is why the CDC has no credibility in setting any guidelines in Lyme treatment. They essentially ignore every clinical study that has been done (all shown below) and came up with their own interpretation after not treating a single patient. The moral of the story is that treating Lyme is as complicated as treating psychiatry. The way the CDC says to test and treat Lyme is equivalent to them saying depression is only this particular set of symptoms and only requires Lexapro for 3 months. If that doesn't fix it, there is nothing else we can do, the problem is something else.
And to reiterate, their methods were never intended to be rigid guidelines. They state that themselves. It was the medical profession that adopted them as bible. In monitoring and surveillance, error is acceptable, because trends can still be seen despite the errors. They are interested in trends, not individual cases:
Your doctor sounds awesome. Trying to provoke a Herxheimer reaction in you with ABX was a genius move. Unfortunately that particular ABX did not rule out other common infections.
Lyme disease is a chronic, persisting, multi-systemic infection, which is caused by Borrelia burgdorferi spirochetes that are transmitted by common deer ticks (Ixodes). Like syphilis, which is another spirochetal infection, Lyme disease may affect several organ systems and proceed through several stages. It may also persist if it is not properly diagnosed and treated in the earliest stage. During the first stage, a pathognomonic bull's eye rash may develop that establishes the diagnosis. It is often accompanied by a flu-like illness. Unfortunately, in 20-50% of those infected with Borrelia, no rash develops, develops in an uncharacteristic form, or is not noticed1,2. Without appropriate antibiotic treatment, the disease becomes disseminated resulting in episodic or persistent neurologic, musculoskeletal, or cardiac symptoms. Several lines of evidence suggest the Lyme disease is very much underreported3 and that perhaps as many as 90% of those affected are not diagnosed.
Ticks that carry the Lyme bacteria also carry co-infections such as Ehrlichia, Babesia, and Bartonella. Approximately 2/3 of patients with Lyme disease have at least one of these co-infections4 but patients are not routinely tested for them. Patients who have Lyme disease together with a co-infection may remain mysteriously ill and unresponsive to standard treatment. Thus, Lyme is a complex illness potentially consisting of multiple tick-derived co-infections.
Most physicians agree that when treated very early in the course of the disease that most Lyme patients will get well. Also generally agreed is that Lyme disease patients who have gone undiagnosed and now suffer late stage disease may continue to experience debilitating symptoms following a month-long course of antibiotics. All agree that these symptoms-arthritic, neurologic, and mulisystemic-can last for months or years. The most controversial aspect of the treatment of late stage Lyme disease is the optimal antibiotic regimen.
For the vast majority of bacterial infections, a defined course of antibiotics either eliminates the bacteria or decreases the number of bacteria so that the immune system can eradicate the survivors. Lyme disease is not a typical bacteria in that it shares some of the characteristics of more challenging bacterial infections such as mycobacteria and syphilis: it is difficult to routinely culture, has a slow growth rate, can remain dormant for lengthy periods5, can invade intracellular sites6,7,8,9, and may sequester in areas where antibiotic penetration is problematic such as the CNS, joint cartilage, and anterior chamber of the eye10. To make matters worse, there are no tests that reliably determine when Borrelia has been effectively eradicated. As clinicians, we are left to use our best medical judgment in individualizing care for our patients.
Oral antibiotics are preferred because of the ease of administration and low cost. Intravenous antibiotics are used for infections that are resistant to orally administered antibiotics, when inadequate blood levels are achieved by the oral route, or when penetration into privileged sites (i.e., the CNS) or poorly vascularized tissue (i.e., cartilage) is needed.
Review of the medical literature to determine an evidenced based approach for the treatment of late Lyme disease reveals a paucity of data. The studies that are often quoted as supporting a particular evidenced-based approach to late Lyme disease are summarized in Appendix A.
There are several themes that run through these diverse studies:
Antibiotics are accepted as mandatory in active Lyme disease treatment. However, the ideal antibiotics, their dosage, route of administration and duration of therapy have not been established.
Many patients remain well after a single course of oral, IM or IV antibiotics. However, many other patients with Lyme disease, initially improve while on antibiotics but relapse when antibiotic treatment is discontinued. There is often relief of symptoms when antibiotics are reinitiated, implying persistence of the bacterial infection.
Many of the antibiotics used in the studies do not penetrate the CNS, such as doxycycline11. Thus, persistence of neuroborreliosis would be expected.
The most effective treatments for late Lyme disease include at least 2 weeks of intravenous ceftriaxone or cefataxime. Retreatment protocols, for relapses and treatment failures, include significantly longer treatment courses, i.e., greater than 4 weeks.
None of the studies included evaluation and treatment for the co-infections such as Rocky Mountain spotted fever, bartonella, babesiosis, or ehrlichia that are present in as many as 2/3 of patients. This may explain the poor response to treatment in some of the studies using 30 days of IV antibiotics.
Persistence12 of symptoms or relapse is quite common13,14 implicating that duration of treatment and/or the type of antibiotic used is inadequate. Relapse and failure to respond to intensive antibiotic treatment has been attributed solely to an autoimmune reaction related to the presence of Borrelia15. However, there are studies documenting the persistence of Borrelia burgdorferi in antibiotic-treated patients16 and following up to 12 months of intravenous antibiotic therapy17,18,19. Appendix B (Download Appendix B PDF) summarizes the studies that demonstrate persistence of Borrelia burgdorferi after antibiotic treatment.
Most of the studies involved highly selected patient populations. Lyme patients present with a broad spectrum of symptoms and response to antibiotics. Thus, the relevance of the conclusions of these studies to most patients with late Lyme disease is problematic.
Many antibiotic regimens do not take into account that many antibiotics only kill actively dividing organisms. The fact that some cultures of Borrelia burgdorferi have taken up to 10 months to grow suggests that most treatment guidelines recommend a too short period of antibiotic treatment20
Given the range of symptoms related to Lyme disease and the widely divergent response to antibiotic therapy, treatment needs to be individualized. This means that some patients may require much longer treatment with oral and/or intravenous antibiotics.
There is not sufficient evidence from the studies published to date to develop treatment guidelines.
In spite of the paucity of data, two groups of physicians that treat Lyme disease independently developed peer-reviewed 'evidence-based' treatment guidelines using the same literature (Appendix A) to formulate their treatment guidelines. The Infectious Disease Society of America (IDSA) advocate a maximum of 30 days of oral or intravenous antibiotics and assume that the remaining symptoms reflect a self-perpetuating autoimmune response21. The International Lyme and Associated Diseases Society (ILADS), which is composed of physicians from a variety of specialties who primarily treat Lyme disease, assume that the persistent symptoms reflect on-going infection and gauge the duration of treatment by the patient's individual clinical response. These physicians believe that there is insufficient evidence at this point to adopt standardized treatment protocols22.While each viewpoint has a strong underlying hypothesis, the scientific evidence supporting either viewpoint is equivocal. Outcomes research is limited and conflicting. The NIAID has only funded three double-blind, placebo-controlled treatment outcome studies for long-term treatment of persistent Lyme disease. The findings of two studies (Klempner and Krupp-Appendix A) are contradictory, with one indicating that continued treatment is beneficial for treating fatigue and the other indicating that it is not. The third NIAID-funded study (Fallon-Appendix A) has recently been completed and preliminary results support continued antibiotic treatment for patients with persistent Lyme disease. The findings of nine non-controlled studies (Appendix A) support continued treatment. The existence of limited or conflicting controlled studies is not uncommon in the practice of medicine.
When a variety of viable treatment options exist, therapy is decided by weighing the individual's risks and benefits. Use of antibiotics can be associated with side effects, allergic reactions, development of drug resistance and cost. The benefits of antibiotics are the relief from a severe multisystemic bacterial infection that is difficult to eradicate with short-term antibiotic treatment. Witholding adequate antibiotic treatment for late-stage Lyme disease (when it is known that Borrelia persist in many treated patients-see Appendix B) (Download Appendix B PDF) is analogous to the Tuskegee experiment performed by the Public Health Service23, which has been widely criticized for the failure to adequately treat African American men with late-stage syphilis, another spirochete disease.
Insurance companies have adopted guidelines reflecting short-term treatment approaches, which are governed by cost-containment considerations. However, the legal standard of care for treating a condition is determined by the consensus of physicians who actually treat patients, not by treatment guidelines24. One survey found that 57% of responding physicians treat persistent Lyme disease for three months or more25. Fallon notes that for over 3400 patients screened for the Columbia University study of persistent Lyme disease, the mean duration of IV treatment was 2.3 months and the mean duration of oral antibiotic therapy was 7.5 months26. In another survey, "50% of the responders considered using antibiotics for a time greater than one year in a symptomatic seropositive Lyme disease patient. Almost that same number would extend therapy to 18 months if needed."27
When more than one standard of care exists, the critical question becomes who decides the appropriate course of treatment for the patient. Under the medical ethical principle of autonomy, the treatment decision belongs to the patient. Hence, the American Medical Association requires that the physician disclose and discuss with the patient not only the risks and benefits of the proposed treatment, but also the risks and benefits of available alternatives28. Treatment choices involve trade-offs between the risks and benefits of treatment options that only patients, who know the kinds of risks they are willing to run and the types of quality of life outcomes that matter to them, are uniquely suited to make.
Insurance companies have placed the full weight of their economic clout behind the less expensive short-term treatment protocols. More expensive longer-term treatment options are discredited as "experimental" or "not evidence-based." The point, of course, is that the science underlying both the short-term and the longer-term treatment options is equally uncertain. It is estimated that only 20% of medicine practiced today is rooted in double-blind studies29 The bulk of medicine today is practiced in the grey zone. Evidence-based medicine requires only that medicine be practiced in accordance with the evidence that currently exists, not that treatment be withheld pending research. As for the cost considerations, healthcare costs generally are lower when the patient's preference is supported30.
In an ideal world, decisions would be based on strong scientific evidence, consensus opinion, and the views of the treating physician. However, seldom are all three available. A recent symposium by the National Institute of Health Care Management Research and Educational Foundation found a general consensus that care should not be denied because evidence is limited, conflicting, or even non-existent. Rather, decisions should be based on the best information available. It has been noted that:
Much, if not most, medical care, even that which is generally accepted in the medical community, would be denied under an evidence-based standard because so few health care services have been subject to rigorous research. At particular risk for denial of needed services are disabled persons because of the lack of treatments proven effective through clinical trials." (Independent Review of Managed Care Decisions by Honorable Mary C. Morgan. (Retired.)
Most patients who require prolonged intravenous antibiotics are denied coverage and subsequently undergo an independent medical review as part of the appeal process. First, it is imperative that those responsible for performing independent medical reviews be made aware of the fact that there are two recognized treatment approaches and that both sets of treatment guidelines be used as part of the review process. Second, the reviewers need to consider all of the data that illustrate the variability of treatment approaches physicians treating persistent Lyme Disease use (see Appendix A for the references). Third, the view of the treating physician needs to be given more weight, given that treatment outcomes research to date illustrate that the population being studied is enormously heterogeneous. In these situations, the clinical course of the individual patient is more a predictor of response to treatment than heterogeneous group studies. Fourth, the variation in treatment practices that currently exists should be resolved by promoting more outcomes research to help resolve the scientific uncertainty and patient's preference should be supported.
There are a number of ways that medical necessity may be determined: on facts and evidence, on a consensus of medical opinion, or on the judgment of individual physicians. Where outcomes research is limited or equivocal, decisions should be based on the best information available which in the case of heterogeneous populations may well be the unique clinical course of the individual patient.
Appendix A
Summary of Clinical Studies for
Treatment of Late Stage Lyme Disease
Randomized placebo-controlled StudiesSteere, 198531 - 40 patients with established Lyme arthritis were randomized to receive weekly IM injections of benzathine penicillin or placebo. 35% of the treated patients had complete resolution of their symptoms and remained symptom-free during a mean follow-up period of 33 months. None of the placebo treated patients improved. As compared with nonresponders, penicillin responsive patients were more likely to have received antibiotics for early Lyme disease and less likely to have received intra-articular steroids.
Klempner, 200132; Kaplan 200333 - 78 seropositive (by Western Blot) and 51 seronegative patients with post-treatment Lyme disease were randomized to receive 30 days IV ceftriaxone followed by oral doxycycline 100mg bid or placebo for 60 days. Patients underwent standardized testing at baseline, 90 and 180 days. There were normal baseline neuropsychological scores in all patients. There were no significant differences between seropositive and seronegative patients in outcomes, nor were there significant differences between treated and untreated patients. Of note is the fact that 64% of patients had persistent symptoms after standard treatment for the disease. Thus, the validity of this study has been questioned.
Krupp, 200334 - Double blind placebo controlled trial on 55 patients with continued fatigue 6 or more months after antibiotic treatment (3 weeks oral Abs or IV ceftriaxone) for Lyme disease. Patients were randomized to receive placebo or 4 weeks of IV ceftriaxone. Outcome measures were fatigue, cognitive speed, and clearance of OspA antigen from the CSF. 64% of patients given antibiotics were improved compared with 18.5% given placebo. Further, for patients with positive western blots at baseline, the responder rate was 80% vs 13%. For seronegative patients, the responder rate was 46% vs 27%. Patients receiving antibiotics also had significantly lower pain scores than those receiving placebo. There were no differences between groups in results of neurocognitive tests. The authors concluded that repeated antibiotic therapy had a substantial positive effect on late Lyme disease outcome.
Fallon, 200435 - completed a trial of 10 weeks of IV antibiotic therapy in patients with late Lyme disease symptoms who had previously been treated with at least 3 weeks of IV antibiotics and then relapsed. There was significant improvement in cognition and other symptoms. This study was part of a $4.7 million NIH funded study. The manuscript is in preparation.
Randomized Trials
Dattwyler, 198836 - 23 patients with clinically active late Lyme disease were randomly assigned to IV treatment with either penicillin or ceftriaxone. Of the 10 treated with penicillin, 5 were judged treatment failures; of the 13 who received ceftriaxone, only 1 patient did not respond. An additional 31 patients were subsequently treated with ceftriaxone with similar results. Patients that were unresponsive to ceftriaxone were more likely to have received corticosteroid treatment.
Pfister, 198937 -21 patients with radiculitis or neuroborreliosis associated with Lyme disease were randomized to receive a 10 day treatment with either IV penicillin G or cefataxime. There were no differences in the outcomes of the two groups. See Pfister, 1991 below.
Hassler, 199038 -135 patients with late-stage Lyme disease were randomized to receive IV penicillin G or IV cefotaxmine for 10 days. Cefotaxamine was significantly more effective than penicillin G with 87.9% vs 61.3% reporting full or partial remission of symptoms 24 months later.
Pfister, 199139 -33 patients with Lyme neuroborreliosis were randomized to receive a 10 day course of either IV ceftriaxone or Cefotaxime. Neurologic symptoms improved or subsided in 26/30 patients-there was no difference in treatment groups. At a mean follow-up of 8 months, 17/27 patients were clinically asymptomatic. Bb was isolated from the CSF of one patient 7 months after ceftriaxone therapy. Since 10 patients remained symptomatic, the authors concluded that a prolongation of therapy might be necessary.
Steere, 199440 -38 patients with Lyme arthritis were randomly assigned to 30 days of treatment with either doxycycline or amoxicillin plus probenecid. Patients who had persistent arthritis 3 months following treatment were given IV ceftriaxone for 2 weeks. 16/18 of the patients treated with amoxicillin and 18/20 treated with doxycycline had resolution of arthritis symptoms within 3 months of treatment. However, neuroborreliosis later developed in 5 patients. Of 16 patients with persistent arthritis who were treated with IV ceftriaxone, none had resolution of arthritis within 3 months. The authors concluded that even with resolution of specific manifestations of Lyme disease with oral antibiotics, there is still a risk of developing additional symptoms of Lyme at a later time. Persistent arthritis may be related to an autoimmune phenomenon (although they did not rule out persistent infection with PCR or culture). Others concluded that 2 weeks of IV ceftriaxone may be insufficient to address Lyme arthritis.
Wahlberg, 199441 -100 consecutive late-Lyme disease patients were treated with different antibiotic regimens and followed up for 12 months after treatment. Treatment outcome was successful in 4/13 patients treated with IV ceftriaxone for 14 days, 50/56 patients treated with ceftriaxone followed by 100 days of amoxicillin with probenecid, and 19/23 of those treated with IV ceftriaxone for 14 days followed by 100 days of cephadroxil.
Okski, 199842 -randomized 60 patients with disseminated Lyme borreliosis based on CDC diagnostic criteria to receive either cefexime and probenecid orally for 100 days or ceftriaxone IV for 14 days followed by oral amoxicillin and probenecid for 100 days. The immediate outcome after antibiotics was not different between the two treatment groups. However, after a year of follow-up, there were significantly greater relapses, treatment failures, and positive PCR tests. The results of this study support the use of intravenous antibiotics along with prolonged antibiotic therapy in patients with late-stage Lyme disease.
Fallon, 199943 -studied 23 Lyme patients who complained of persistent memory difficulties after IV antibiotic therapy of 4-16 weeks. Four months after their initial treatment, 18 of the patients received additional IV antibiotics and compared with the others who did not receive additional antibiotics. Those receiving additional IV antibiotics scored better on cognition tests, greatest functional improvement in energy, pain, and physical functioning than untreated patients. Based on the results from this pilot study, the authors concluded that there was enough evidence to plan a larger study investigating the utility of repeated courses of IV antibiotics (see Fallon, 2004).
Logigian, 199944 -a series of 18 consecutive patients with Lyme encephalopathy and symptoms of memory difficulty, minor depression, somnolence, or headache were treated with 30 days of IV ceftriaxone. At the beginning of treatment, 89% had abnormal memory scores, 89% had CSF abnormalities and all tested had perfusion defects on SPECT scan. Six months after treatment, memory scores were significantly improved, CSF protein levels were significantly less, and post-treatment perfusion was significantly improved. 12-24 months after treatment, all patients rated themselves as improved or back to normal.
Observational studies
Hassler, 199145 -reported on two patients with antibiotic resistant Lyme disease that were treated with pulsed high-dose cefataxime with 2 days of treatment followed by 6 days without antibiotics over a ten-week period of time. One patient was symptom-free 6 months after antibiotic treatment, the other was improved and skin biopsies showed no evidence of Borrelia.
Cimmino, 199246 -reported 2 cases of chronic Lyme arthritis, refractory to standard antibiotic treatment, who were treated with weekly intramuscular Benzathine penicillin 2.4 million units and were cured.
Valesov, 199647 -reported on the outcome of a 36-month follow-up of patients with late stage Lyme arthritis after 2 weeks of ceftriaxone therapy. At 36 months 19/26 continued to be symptom-free, 6 had relapsed and 1 presented with new late-Lyme symptoms.
Donta, 199748 -277 patients with chronic Lyme disease and symptoms of fatigue, musculoskeletal pain, neuropsychiatric dysfunction, and paresthesias were treated with tetracycline for 1-11 months (mean 4 months). Overall 20% of the patients were cured, 70% significantly improved (degree of improvement 75-100%), and 10% did not improve. Improvement frequently did not take place for several weeks: after 2 months of treatment, 33% were significantly improved, after 3 months 61% were significantly improved. Improvement showed as early as one to two weeks after the start of treatment; however, in patients who were symptomatic for more than a year, it frequently took 4-6 weeks on the antibiotic for evidence of improvement. This slow rate of improvement was postulated to be due to the slow rates of multiplication and metabolism in Borrelia. This study underscores the necessity of an individualized approach to the treatment of late-stage Lyme disease.
Okski, 199949 -13 patients who had clinical relapses and were PCR positive after at least 3 months of oral antibiotics were treated with IV ceftriaxone for 4-6 weeks. None of the patients were PCR positive after treatment and 9 showed good therapeutic responses. The authors concluded that treating late Lyme disease with appropriate antibiotics for more than 3 months may not always eliminate Borrelia and that longer courses may be necessary.
Donta, 200350 -235 patients with chronic Lyme disease symptoms of fatigue, musculoskeletal pain, and neurocognitive dysfunction with positive serology for Borrelia were treated with macrolide antibiotics and hydroxychloroquine for one or more months based on their level of improvement during the course of treatment. 120 patients who were improved at the discontinuation of therapy had relapsing symptoms and were retreated with antibiotics. Of those retreated with macrolide/hydroxychloroquine, 32/33 had improvement, tetracycline 54/74 had improvement, IV ceftriaxone 9/23 had improvement. Thus, tetracycline and IV ceftriaxone had a much lower success rate than macrolide/hydroxychloroquine therapy.
Reviews
Cimmino, 199651 -reviewed the results of antibiotic treatment of Lyme arthritis in peer-reviewed journals between 1985 and 1991. The studies were small or medium-sized and not blinded. The antibiotics included Benzathine penicillin, IV penicillin G, IV ceftriaxone, IV Cefotaxime, oral doxycycline or oral amoxicillin plus Probenecid. The authors concluded that "There is no consensus on the therapeutic protocol to be adopted in Lyme arthritis. Many questions are still open about the antibiotic agents to adopt as well as the best duration of treatment."
Jacobs, RA. Infectious Diseases: Spirochetal. Current Medical Diagnosis and Treatment (Lange Medical Books/McGraw-Hill, NY, 39th edition, 2000
Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Infect Dis 1997; Suppl 1:S52-S56
United States of America Department of Health and Hyman Services Food and Drug Administration Center for Biologics Evaluation and Research Vaccines and Related Biological products Advisory Committee Meeting, May 26, 1998
Benach JL, Coleman JL, Habicht GS: Serologic evidence for simultaneous occurrences of Lyme disease and babesiosis. J Infect Dis 144:473-477, 1981
Preac-Mursic V, et al. Formation and Cultivation of Borrelia burgdorferi Spheroblast-L Form Variants. Infection 24(1996);3.
Klempner et al. Invasion of Human Skin Fibroblasts by the Lyme Disease Spirochete, Borrelia burgdorferi. J Infect Diseases 1993;67:1074-81.
Ma et al. Intracellular localization of Borrelia burgdorferi within human endothelial cells. Infect Immun 1991;59:671-78.
Duray PH, Johnson RC. The histopathology of experimentally infected hamsters with the Lyme disease spirochete, Borrelia burgdorferi. Proc Soc Exp Biol Med. 1986: 263-269.
Georgilis et al. Fibroblasts Protect the Lyme Spirochete, Borrelia burgdorferi, from Ceftriaxone in vitro. J. Infec. Dis. 1992:166:440-4.
Jaruratanasirkul et al. Distribution of Azithromycin into brain tissue, cerebrospinal fluid, and aqueous humor of the eye. Anti Agents Chemo 40:825-26, 1996
Chopra et al. Tetracycline antibiotics: mode of action, applications, molecular biology, and epidemiology of bacterial resistance. Microbiol Mol Biol Rev 65: 232-60, 2001
Klempner et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 345:85-92, 2001
Asch et al. Lyme disease: An infectious and postinfectious syndrome. J Rheum 21:454-60, 1994
Valesov et al. Long-term results in patients with Lyme arthritis following treatment with ceftriaxone. Infec 24:98-102, 1996
Steere et al. Treatment of Lyme arthritis. Arth Rheum 37:878-88, 1994
Schmidli et al. Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis. J Infect Dis 1988;158:905-6.
Haupl, et al. Persistence of B. burgdorferi in Ligamentous Tissue from a Patient with Chronic Lyme Borreliosis. Arthritis Rheum 1993; 36:1621-6.
Pfister et al. Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. J Infect Dis. 1991; 163(2): 311-318.
Hassler et al. Pulsed High Dose Cefotaxime Therapy in Refractory Lyme Borreliosis (Letter) Lancet; 338:193.
MacDonald et al. Clinical implications of delayed growth of the Lyme borreliosis spirochete, Borrelia burgdorferi. Acta Tropica 1991;48:89-94.
Wormser, et al., Practice guidelines for the treatment of Lyme disease. The Infectious Diseases Society of America. Clin Infect Dis, 2000. 31 Suppl 1: p. 1-14.
The International Lyme and Associated Diseases Society (ILADS), Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti-infect Ther, 2004. 2(Suppl): p. S1-S13.
Jones, JH. Bad Blood: The Tuskegee Syphilis Experiment, , expanded edition (New York: Free Press, 1993).
Hurwitz, B., Clinical guidelines and the law. BMJ, 1995. 311: p. 1517-1518
Ziska, et al. Physician preferences in the diagnosis and treatment of Lyme disease in the United States. Infection, 1996. 24(2): p. 182-6.
Fallon, B.A., Testimony at public hearings in re Lyme disease for the State of Connecticut Department of Public Health. 2004: p. 134-153.
Katzel, J., Is there a consensus in treatment of Lyme Borreliosis?, in Lyme Disease 1991 Patient/Physician Perspectives from the U.S. & Canada, L. Mermin, Editor. 1992.
American Medical Association, Code of Medical Ethics.
Hitt, J., The year in ideas: a to z.; evidence-based medicine., in New York Times (December 9, 2001, Sunday).
Wennberg, et al. Geography and the debate over Medicare reform. Health Aff (Millwood), 2002. Supp Web Exclusives: p. W96-114.
Steere et al. Successful parenteral penicillin therapy of established Lyme arthritis. N Engl J Med 312:869-74, 1985
Klempner et al, Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 345:85-92, 2001
Kaplan et al, Cognitive function in post-treatment Lyme disease: Do additional antibiotics help? Neurology 60:1916-1922, 2003
Krupp et al. Study and treatment of post Lyme disease. A randomized double masked clinical trial. Neurology 60:
In preparation.
Dattwyler et al. Treatment of late Lyme borreliosis-randomized comparison of ceftriaxone and penicillin. Lancet, May 28: 1191-4, 1988
Pfister et al. Cefotaxime vs penicillin F for acute neurologic manifestations in Lyme borreliosis. A prospective randomized study. Arch Neurol 46:1190-4, 1989
Hassler et al. Cefotaxime versus penicillin in the late stage of Lyme disease-prospective, randomized therapeutic trial. Infection 18:16-20, 1990
Pfister et al. Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. J Infect Dis 163:311-18, 1991
Steere et al. Treatment of Lyme arthritis. Arthritis Rheum 37:878-88, 1994
Wahlberg et al. Treatment of late Lyme borreliosis. J Infec 29:255-61, 1994
Oski, et al. Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis. Eur J Clin Microbiol Infec Dis 17:715-19, 1998.
Fallon et al. Repeated antibiotic treatment in chronic Lyme disease. J Spirochetal Tick Dis 6:94-101, 1999
Logigian et al. Successful treatment of Lyme encephalopathy with intravenous ceftriaxone. J Infec Dis 180:377-83, 1999
Hassler et al. Pulsed high-dose cefotaxime therapy in refractory Lyme borreliosis. The Lancet 338:1991
Cimmino et al. Long-term treatment of chronic Lyme arthritis with Benzathine penicillin. Ann Rheum Dis 51:1007-8, 1992
Valesov et al. Long-term results in patients with Lyme arthritis following treatment with ceftriaxone. Infection 24:98-102, 1996
Donta ST. Tetracycline therapy for chronic Lyme disease. Clin Infect Dis 1997; Suppl 1:S52-S56
Oksi et al. Borrelia burgdorferi detected by culture and PCR in clinical relapse of disseminated Lyme borreliosis. Annals of Medicine 31: 225-32, 1999b
Donta ST. Macrolide therapy of chronic Lyme disease. Med Sci Monit 9:136-142, 2003
Cimmino et al. Treatment of Lyme arthritis. Infection 1:91-94, 1996
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